DESCRIPTION/ABSTRACT: Dementia is a major burden, costing more than cancer and heart disease, and expected to double by 2060, and disproportionately in African-Americans. Among the parameters leading to post stroke dementia (PSD), vascular causes, including small vessel disease, represent a silent epidemic in need of further characterization epidemiologically. Further population-based studies of PSD, both in terms of incidence and characterization, are needed in the United States to allow for national projections and public health planning. Currently, we also lack an established prediction tool for PSD. A Framingham-like ?Risk Function Tool for Post-Stroke Dementia,? especially one incorporating the full gamut of modern imaging parameters developed in a racially diverse population, would likely identify high-risk patients for targeted interventions. Moreover, it may reveal novel causal pathways and risk factors for future investigation. We propose an ancillary study to the NIH-funded Assessing Population-based Radiological brain health in Stroke Epidemiology (APRISE) study entitled, APRISE-Dementia. Our objective is to build on the GCNKSS and APRISE infrastructures which will have radiologically characterized the full stroke/TIA population of Greater Cincinnati/Northern Kentucky from 2015 and created the first modern, largely MRI-based characterization of brain health in a contemporary stroke/TIA population, and determine the population-based incidence, clinical and demographic features, and predictors of PSD up to five years after the incident stroke/TIA. Our specific aim is to create a prediction model of PSD incorporating imaging parameters in a biracial ischemic stroke/hemorrhagic stroke/TIA population using state-of-the-art modeling approaches. We hypothesize that diagnosis of PSD (within five years from index stroke event) will be better predicted by incorporating imaging parameters compared to traditional vascular risk factors alone. We will achieve these goals in a remarkably cost- and time-efficient manner by leveraging the extensive imaging, clinical and demographic data of stroke/TIA patients from 2015 already being collected in the currently funded APRISE and GCKNSS grants. Our project will not only provide the first population-level incidence of PSD projected nationally and innovatively utilize the entire imaging spectrum of brain health for prediction, but it will also generate novel hypotheses for prospective validation and refinement in the prospective NINDS/NIA- funded U19 DISCOVERY cohort. With the infrastructures already in place, we are uniquely ready to address these urgent questions.